Gynécologie, obstétrique & fertilité
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Gynecol Obstet Fertil · Nov 2012
[Preoperative imaging of deeply infiltrating endometriosis in: Transvaginal sonography, rectal endoscopic sonography and magnetic resonance imaging].
Compare the accuracy of transvaginal ultrasonography (TVUS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI) before deeply infiltrating endometriosis surgery. ⋯ We found that TVUS is the more performant for endometriomas, it is MRI for torus, uterosacral ligaments and little bladder lesions, RES for rectovaginal septum and rectosigmoid junction. So in the clinical practice, the three imaging examinations are complementary for the preoperative assessment of deeply endometriosis.
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Magnesium sulfate (MgSO(4)) is the best treatment of eclampsia, reduces the risk of recurrence better than other anticonvulsants and is recommended as first line in cases of eclampsia. In cases of severe pre-eclampsia and especially when prodromes are present, MgSO(4) reduces better than conventional anticonvulsants the risk of eclampsia. ⋯ These trials were included in three meta-analyzes that showed a 30% reduction in the incidence of cerebral palsy before 32 weeks gestation suggesting that this drug should be used in cases of preterm birth. A protocol using low doses associated with a well-conducted maternal surveillance reduces of maternal hypermagnesemia and the risk of maternal toxicity.
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Gynecol Obstet Fertil · Apr 2012
Case Reports[Diagnosis and treatment of pelvic splenosis during exploration of infertility].
Splenosis is the heterotopic autotransplantation of splenic tissue that usually follows traumatic splenectomy. Rare pelvic localizations are reported. We report here a case of a 36-year-old woman, followed for secondary infertility. ⋯ Pelvic splenosis was suspected regarding the patient's medical past (post-traumatic splenectomy). Surgical exploration and resection were decided considering the nodule localization, the risk during ovarian punction for IVF, and the hypothetical risk of bleeding at delivery. Generally, it is recommended to leave in place the splenic tissue, which may be immunologically functional.
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Hot flushes experienced by breast cancer survivors present specific issues due to their frequency, severity and difficulty to treat. After an evaluation of her symptoms and expression of her expectations and requests, each patient will be provided a clear, synthetic, comprehensible, supported and prioritized view of all treatment options. Any prescribed treatment will be a shared medical decision making. ⋯ In case of inefficiency, treatments of second- and third-line will be proposed. Prescription of progestin or of a menopausal hormone therapy should remain exceptional and limited to cases where all other treatments failed, after obtaining the patient's informed consent following exhaustive information. Indications of stellate ganglion block remain to be defined.